Professional Documents
Culture Documents
Dewi Kartikawati N.
Structure and Function
Gas Exchange
Changes Associated to Aging
recoil and compliance
AP diameter
functional alveoli
in Pa02
Respiratory defense
mechanisms less effective
Altered respiratory controls
More gradual response to
changes in O2 and Co2
levels in blood
Pneumonia Definition
An acute infection of the pulmonary parenchyma that is
associated with at least some symptoms of acute infection,
accompanied by an acute infiltrate on CXR or
auscultatory findings consistent with pneumonia
Pneumonia
The major cause of death in the world
RUL LUL
RUL LUL
Lingula
RML
Lingula
LLL RM
RLL
L
LLL
RLL
Chest X-ray Pneumonia
Chest X-ray - Pneumonia
Chest X-ray -- Pneumonia
Types of Pneumonia
Community-Acquired (CAP)
Health-Care Associated Pneumonia (HCAP)
Hospitalization for > 2 days in the last 90 days
Residence in nursing home or long-term care facility
Home Infusion Therapy
Long-term dialysis within 30 days
Home Wound Care
Exposure to family members infected with MDR bacteria
Hospital-Acquired Pneumonia (HAP)
Pneumonia that develops after 5 days of hospitalization
Includes:
Ventilator-Associated Pneumonia (VAP)
Aspiration Pneumonia
Common Bugs for Pneumonia
Community-Acquired HCAP or HAP
Streptococcus pneumoniae
Pseudomonas aeruginosa
Mycoplasma pneumoniae
Staphylococcus aureus
Chlamydophila psittaci or
pneumoniae (Including MRSA)
Legionella pneumophila
Klebsiella pneumoniae
Haemophilus influenzae
Serratia marcescens
Moraxella catarrhalis
Staphylococcus aureus
Acinetobacter baumanii
Nocardia
Mycobacterium tuberculosis
Influenza
RSV
CMV
Histoplasma, Coccidioides,
Blastomycosis
Diagnosis of pathogen
Sputum Culture
< 10 Squamous Epithelial Cells
> 25 PMNs
Blood Cultures
Strep. pneumo urinary antigen
Legionella urinary antigen
HIV test?
Special Clues on Chest X-ray
Pulse Oximetry
Pulmonary Function Tests
Chest X-Ray
Sputum Specimen and Cultures
Computed Tomography
(CT scan)
Bronchoscopy
Thoracentesis
Diagnostics: Pulse Oximetry
Measures arterial oxygen
saturation
Pulse oximetry probe on
forehead, ears, nose, finger,
toes,
False readings
Intermittent or continuous
monitoring
Ideal values: 95-100%
When to Notify MD
< 91%
86% (Medical Emergency)
Diagnostics: Chest X-Ray
Screen, diagnose,
evaluate
treatment
Instructions: No
metals/jewelry
Diagnostics: Chest X-Ray Cont.
Nodule
Infiltrates
Procedure Care/Instructions:
Diagnose problems and assess NPO 6 -8 hrs prior
changes in
bronchi/bronchioles Sedation during procedure
Performed to remove foreign Post Procedure:
body, secretions, or to obtain HOB elevated
specimens of tissue or mucus
for further study Observe for hemorrhage
NPO until gag reflex returns
Diagnostics: Pulmonary Function Test
(PFTs)
Evaluate lung function
Instruction: No
bronchodilators 6 hours
prior
Diagnostics: Thoracentesis
Specimen from pleural
fluid
Treat pleural effusion
Assess for complications
Post-Procedure care:
CXR after procedure
Positions
Sitting on side of bed over bedside table
chest
elevated
Lying on affected side
Straddling a chair
Pneumonia: Complications
Hypoxemia
Pleural
effusion
Atelectasis
Atelectasis Pleurisy
Pleurisy
Pleural Effusion
Toxic sprinkles anyone?
Any Questions?